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Full text of "Rapid Population Growth Consequences And Policy Implications"

even though cities have been increasing in size since 1940, death rates have fallen more rapidly in these crowded circumstances than in the more sparsely populated rural areas. Part of this phenomenon may be due to the improved medical care and sanitation in the cities and part to the migration of younger people to the cities, which leaves an older, more susceptible population behind in the rural areas. These processes, it could be argued, might overwhelm or obscure the effects of crowding. That they can be only partial explanations for this reversal in the rural-urban health ratios is evident from the data in Tables 1 and 2. The rural excess in incidence from typhoid fever, for example, may well be due to differences in sanitation, and the more effective immunization programs in cities may account for the lower urban rates of diphtheria and pertussis. However, the rural excess in the incidence of scarlet fever can hardly be due to either of these processes, as we do not as yet possess any means to prevent the occurrence of streptococcal infections. Similarly, as far as the migration hypothesis is concerned, this could not explain the excess mortality rates in rural children both black and white, male and female.
TABLE 1
Urban-Rural Differences in Health Status, United States, 1959-1961: Total Mortality Rates per 100,000 Population
All Causes,
Children Age                                  Metropolitan                               Nonmetropolitan
5-14 Years                                       Counties                                        Counties
White Male                                              48.6                                               59.7
White Female                                          32.3                                               37.6
Nonwhite Male                                        67.5                                               82.3
Nonwhite Female                                    45.5                                               60.9
Source: (10)
Data from other parts of the world tend to confirm this seeming paradox. DuBos (8), for example, reports that despite the fact that Hong Kong and Holland are among the most crowded areas in the world, they enjoy one of the highest levels of physical and mental health in the world. Even more convincing is the data from Britain, where in 1961 the age-standardized mortality ratios for all causes of death were as follows:* (9)
*Age-standardized mortality ratio as defined by the Registrar General is "the number of deaths occurring in each sex aged 20-64 in a given place of residence expressed as a percentage of the number of deaths that might have been expected to occur if the given place of residence had experienced within each age group the same death rate as that of a standard population...." Thus for each sex group a standardized mortality ratio of 100